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Page: << Prev | 1 | 2 Use of a bare-metal stent versus a drug-coated stent thus depends on a recipient's risk profile, Tu said. "Unless I were a high-risk patient with two or three risk factors, I would be better off with a bare-metal stent," he said. I would reserve the coated stent for high-risk patients.
Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said the findings should be interpreted with care, because the study was "observational," looking at what was done in medical practice without the strict effort to balance all factors done in a controlled trial.
"Observational data has significant limitations, particularly that the patients who received bare-metal stents rather than coated stents may have been different," Nissen said. "Observational studies try to account for those differences by matching patients carefully, but matching is an imperfect science."
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The "big surprise" of the study was the reduction of the death rate with drug-eluting stents, Nissen said. "But the authors appropriately caution that the finding needs confirmation by randomized clinical trials," he said.
"In my view, we've learned all we can from observational trials," Nissen added. "We need a good long-term controlled trial" of stents.
However, Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City, said the Canadian trial was no ordinary observational study.
"The best thing about this paper is the technique they used for matching bare-metal stent patients with drug-coated stent patients," Garratt said. "It was easy for me to figure out quickly and easily the impact of having put a drug-coated stent into a patient. It was linked to an important improvement in how patients do over a long period of time."
One reason the coated stents performed so well is that Canada's health-care system automatically provides the clot-preventing drug Plavix, plus aspirin, for all stent recipients. Those drugs are recommended for American recipients, and the federal government recently began to pay for them, Garratt said.
"That is reason to hope that the U.S. population will see these benefits in the next few years," he said.
More information
You can learn why and how stents are used from the U.S. National Heart, Lung, and Blood Institute.
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